Abstract
Splenic injury is usually caused by blunt trauma to the abdomen. Very rarely, spontaneous rupture can occur in patients with splenomegaly due to various underlying pathological conditions such as hematological, neoplastic, inflammatory, and infectious diseases. Here, we report the case of a 48-year-old gentleman who presented to the emergency department with sudden-onset pain in the abdomen and hypotension. Blood investigation revealed anemia and leukocytosis with blast cells on peripheral smear, suggestive of chronic myeloid leukemia (CML) in the chronic phase. Contrast-enhanced computed tomography revealed splenomegaly with grade three splenic laceration and a subcapsular hematoma with hemoperitoneum. Because of persistent hemodynamic instability, despite resuscitation, he underwent emergency splenectomy. The postoperative period was uneventful. Bone marrow biopsy revealed CML in the chronic phase with World Health Organization grade I reticulin fibrosis. Subsequently, he was started on hydroxyurea and discharged for further follow-up with medical oncology.
Highlights
Spontaneous splenic rupture (SSR) is a rare clinical entity, with life-threatening complications [1]
We present a rare case of SSR as the index presentation of chronic myeloid leukemia (CML)
It occurs in patients with splenomegaly due to various underlying pathological conditions, such as (i) neoplastic (30.3%): hematological such as chronic lymphocytic leukemia, Hodgkin’s lymphoma, CML, and non-hematological such as angiosarcoma; (ii) infectious diseases (27.3%) such as malaria, mononucleosis, and other viral infections; (iii) inflammatory disorders (20%) such as pancreatitis, abscess, amyloidosis; and (iv) drugs and chemotherapy such as filgrastim (6.8%) [2]
Summary
Spontaneous splenic rupture (SSR) is a rare clinical entity, with life-threatening complications [1]. There was no history of trauma or any surgery On presentation, he was conscious and oriented, with tachycardia (120 beats/minutes) and hypotension (90/60 mmHg). How to cite this article Vemulakonda S, S S, Jain A, et al (November 16, 2021) A Rare Case of Spontaneous Splenic Rupture as the Index Presentation of Chronic Myeloid Leukemia. Spleen was enlarged (18 cm) with a 3 cm laceration in the lower pole and a ruptured subcapsular hematoma (Figure 2) He was transfused with four units of packed cells, fresh frozen plasma, and platelets. Histopathological examination of the spleen revealed features consistent with CML in the chronic phase (Figure 3). He was started on hydroxyurea and discharged for further follow-up with medical oncology
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